Laserfiche WebLink
UST SYSTEM RETROFIT OR REPAIR <br />(Submit minimum of 2 sets of plans & applications as originals will be retained by EHD) <br />1. Site map enclosed YES [I NO (I <br />2. Manufacturer's spec sheets attached for all equipment to be installed YES [ ] NO [ ] <br />3. Description of work to be completed (if adding piping, UDC's, or other UST equipment, or performing tank top upgrade, <br />ust he USTIrnstatlatjo?Aplicaoti n pages," as necessary for a`timely plan review):, , � � ® � � A <br />4. Description of equipm t o b used Atta dra p ' is as necessary : <br />erg r r b S� f D 1 cEi <br />5. All equipment is State certified or approved. YES [I NO [I <br />6. Decontamination Procedures: <br />a. Will piping be decontaminated prior to removal? YES [ ] NO [ ] <br />b. Identify contractor performing decontamination: <br />Name Phone, <br />Address City - Zip <br />c. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite pry to manifesting offsite: <br />e. Rinsate Hauler and permitted Treatm6nt, Storage & Disposal Facility: <br />Hauler Name Phone(_) Hauler Reg# <br />Address City Zip <br />Permitted Disposal Site <br />7. a. Describe the method that will be utilized to purge and/or inert the piping: <br />b. Piping Hauler. <br />Name Phone (T) <br />Address City Zip <br />Hauler Registration # (if hauled as hazardous) <br />c. Piping Disposal Site: <br />Name Phone <br />Address City Zip <br />EPA ID# (if transported to a permitted TSD facility) <br />8. Is the sampling firm an independent third party from the contractor? YES [ ] NO[] <br />9. Describe, in detail, how the soil and/or water sample(s) beneath the piping or dispenser will be obtained: <br />10. Handing of excavated soil (Contaminated'Soll Hazardous Waste Hauler): <br />Name Hauler Registration # Phone <br />Address City W Zip <br />b) If soil is not to be hauled, describe what will be done with it: <br />2 <br />